Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2010 and ending 06-30-2011
BCheck if applicable:
CName of organization
GASTON MEMORIAL HOSPITAL INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
2525 COURT DRIVE PO BOX 1747
 
Room/suite
City or town, state or country, and ZIP + 4
GASTONIA, NC280531747
D Employer identification number

56-0619359
E Telephone number

G Gross receipts $ 410,972,492
F Name and address of principal officer:
DAVID O'CONNOR
2525 COURT DRIVE PO BOX 1747
GASTONIA,NC280531747
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.CAROMONT.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1945
M State of legal domicile: NC
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO PROVIDE EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 14
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 11
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 3,023
6 Total number of volunteers (estimate if necessary) .... 6 291
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 619,518
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 74,649
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 373,678 119,286
9 Program service revenue (Part VIII, line 2g) ......... 378,127,914 405,735,809
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 112,375 41,896
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 5,155,165 5,018,302
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 383,769,132 410,915,293
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 88,799 257,503
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 157,119,443 163,004,927
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 200,992,995 214,831,055
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 358,201,237 378,093,485
19 Revenue less expenses. Subtract line 18 from line 12...... 25,567,895 32,821,808
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 324,420,647 332,063,801
21 Total liabilities (Part X, line 26)............ 314,318,521 307,061,339
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 10,102,126 25,002,462
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: TO PROVIDE EXCEPTIONAL HEALTH CARE TO THE COMMUNITIES WE SERVE.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 351,817,543 including grants of $ 257,503 ) (Revenue $ 405,678,029 )
GASTON MEMORIAL HOSPITAL PROVIDES INPATIENT, OUTPATIENT, EMERGENCY, AND SURGICAL SERVICES TO THE RESIDENTS OF GASTON COUNTY AND SURROUNDING AREAS AT ITS 435 BED ACUTE CARE FACILITY.PLEASE SEE SCHEDULE O FOR A CONTINUATION OF OUR PROGRAM SERVICE ACCOMPLISHMENTS.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services. (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 351,817,543
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. ..... Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
 
No
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
341
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
3,023
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
14
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
11
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
NC
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
DAVID O'CONNOR
2525 COURT DRIVE
GASTONIA,NC28054
(704) 834-2000
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) H SPURGEON MACKIE JR
CHAIRMAN
 1.00 X   X       0 0 0
(2) SHEILA S REILLY PHD
VICE CHAIR
 1.00 X   X       0 0 0
(3) DR ROBERT D CROUCH
SECRETARY
 1.00 X   X       0 0 0
(4) WILLIAM K GARY SR
TREASURER
 1.00 X   X       0 0 0
(5) MARY FRANCES FORRESTER
DIRECTOR
 1.00 X           0 0 0
(6) KELVIN C HARRIS MD
DIRECTOR
 1.00 X           0 231,676 17,761
(7) JAMES H HOWARD JR
DIRECTOR
 1.00 X           0 0 0
(8) JAMES R BEAM
DIRECTOR
 1.00 X           0 0 0
(9) RICHARD K CRAIG
DIRECTOR
 1.00 X           0 0 0
(10) MICKEY PRICE
DIRECTOR
 1.00 X           0 0 0
(11) DR KATHY DRUM
DIRECTOR
 1.00 X           0 0 0
(12) DAVID ALLEN SMITH
DIRECTOR
 1.00 X           0 0 0
(13) M VINCENT QUINN
DIRECTOR
 1.00 X           0 0 0
(14) W BARRY SMITH
DIRECTOR
 1.00 X           0 0 0
(15) DR JOHN L SCHEITLER
CHIEF-OF-STAFF
 1.00 X           20,855 0 0
(16) DR H CLAYTON THOMASON III
PAST CHIEF-OF-STAFF
 1.00 X           30,000 0 0
(17) VALINDA L RUTLEDGE
CEO
 40.00     X       1,076,425 0 38,634
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) DAVID O'CONNOR
CFO/ASST. TREASURER
 40.00     X       692,572 0 39,820
(19) MARIA LONG
EVP GEN. COUNSEL/ASST. SEC.
 40.00     X       487,588 0 33,654
(20) JAMES D HUBER
VP MEDICAL SERVICES
 40.00       X     527,556 0 24,567
(21) STEVEN A RUBIN
VP PRACTICE MANAGEMENT
 40.00       X     461,803 0 48,507
(22) TERRY L JONES
EVP/CAO
 40.00       X     816,277 0 90,600
(23) W K HARWELL
VP PATIENT CARE SERVICES - FORMER KE
 40.00         X   446,012 0 139,707
(24) ANDREA K SERRA
VP WELLNESS - FORMER KE
 40.00         X   385,625 0 46,032
(25) MICHAEL R JOHNSON
AVP, CIO
 40.00         X   288,841 0 61,392
(26) ROWENA BUFFETT TIMMS
VP OF PUBLIC POLICY
 40.00         X   306,035 0 17,060
(27) KATHLEEN L BESSON
VP OF CLINICAL OPS
 40.00         X   276,676 0 44,064
(28) WAYNE F SHOVELIN
FORMER CEO
 0.00           X 5,914,978 0 0




1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 11,731,243 231,676 601,798
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet113
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
SHARED (SIEMENS) MEDICAL SOLUTIONS
51 VALLEY STREAM PARKWAY
MALVERN,PA19355 		INFORMATION SYSTEMS 4,991,005
MORRISON MANAGEMENT SPECIALISTS INC
3 WACHOVIA CENTER STE 3000 401 S
CHARLOTTE,NC28202 		FOOD SERVICES MANAGEMENT 4,248,818
ARAMARK CTS
12483 COLLECTIONS CENTER DRIVE
CHICAGO,IL60693 		BIOMED SERVICES 2,140,200
GASTON ANESTHESIA ASSOCIATES
PO BOX 601713
CHARLOTTE,NC28260 		CRNA SERVICES 2,126,193
REHABCARE GROUP
7733 FORSYTH BLVD STE 1700
ST LOUIS,MO63105 		OP REHAB SERVICES 1,268,959
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet46
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		119,286
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 119,286
Program Service Revenue Business Code
2a PATIENT SERVICES REVEN 621,500 404,550,934 404,068,809 482,125  
b PARTNERSHIP INCOME 541,900 853,266 851,585 1,681  
c AUXILIARY INCOME 621,500 331,609 219,897 111,712  
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 405,735,809
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 99,095     99,095
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross Rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses   57,199
c Gain or (loss)   -57,199
d Net gain or (loss)..........MediumBullet -57,199     -57,199
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a PHARMACY REVENUE 621,500 2,173,456     2,173,456
b CAFETERIA & VENDING IN 722,210 2,048,851     2,048,851
c DISCOUNTS & REBATES 621,500 537,738 537,738    
d All other revenue .... 258,257   24,000 234,257
e Total. Add lines 11a–11d ......MediumBullet 5,018,302
12 Total revenue. See Instructions....MediumBullet 410,915,293 405,678,029 619,518 4,498,460
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 257,503 257,503
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 4,508,634 919,053 3,589,581  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 54,468 54,468    
7 Other salaries and wages 127,338,862 116,843,848 10,495,014  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 5,979,786 5,343,975 635,811  
9 Other employee benefits ....... 15,821,584 14,199,224 1,622,360  
10 Payroll taxes ........... 9,301,593 8,312,586 989,007  
11 Fees for services (non-employees):        
a Management ...... 509,315   509,315  
b Legal ......... 418,205 57,011 361,194  
c Accounting ........... 27,388   27,388  
d Lobbying ........... 263,852   263,852  
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ......        
g Other .......... 39,084,210 35,888,182 3,196,028  
12 Advertising and promotion .... 1,056,718 138,623 918,095  
13 Office expenses ....... 2,655,004 1,568,135 1,086,869  
14 Information technology ...... 373,125 373,125    
15 Royalties ..        
16 Occupancy ........... 9,167,315 9,167,315    
17 Travel ............ 123,150 63,134 60,016  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 799,649 324,511 475,138  
20 Interest ........... 11,114,018 11,114,018    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 26,833,269 26,833,269    
23 Insurance .............. 1,369,881   1,369,881  
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a MEDICAL SUPPLIES 73,237,048 72,963,654 273,394  
b BAD DEBT 40,115,742 40,115,742    
c EQUIPMENT 5,529,915 5,497,322 32,593  
d RECRUITING 1,681,816 1,647,401 34,415  
e MISCELLANEOUS 418,078 135,444 282,634  
f All other expenses 53,357   53,357  
25 Total functional expenses. Add lines 1 through 24f 378,093,485 351,817,543 26,275,942 0
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... -3,285 1 -5,240
2 Savings and temporary cash investments .......   2  
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 33,966,858 4 43,641,842
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 5,676,105 8 6,558,153
9 Prepaid expenses and deferred charges ............ 7,706,644 9 8,288,591
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 490,703,793
b Less: accumulated depreciation. ..... 10b 285,794,159 207,276,220 10c 204,909,634
11 Investments—publicly traded securities .......... 17,892 11 9,873
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 .. 349,220 13 380,625
14 Intangible assets ......... 2,311,646 14 2,311,646
15 Other assets. See Part IV, line 11 ........... 67,119,347 15 65,968,677
16 Total assets. Add lines 1 through 15 (must equal line 34)... 324,420,647 16 332,063,801
Liabilities 17 Accounts payable and accrued expenses . 34,757,005 17 39,454,843
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities .......... 219,898,498 20 213,332,101
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 59,663,018 25 54,274,395
26 Total liabilities. Add lines 17 through 25..... 314,318,521 26 307,061,339
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 10,102,126 27 24,995,463
28 Temporarily restricted net assets .....   28 6,999
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 10,102,126 33 25,002,462
34 Total liabilities and net assets/fund balances ..... 324,420,647 34 332,063,801
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
410,915,293
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
378,093,485
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
32,821,808
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
10,102,126
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
-17,921,472
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
25,002,462
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
GASTON MEMORIAL HOSPITAL INC
 
Employer identification number

56-0619359
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
GASTON MEMORIAL HOSPITAL INC
 
Employer identification number

56-0619359
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
GASTON MEMORIAL HOSPITAL INC
  		Employer identification number

56-0619359
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
GASTON MEMORIAL HOSPITAL INC
  		Employer identification number

56-0619359
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
GASTON MEMORIAL HOSPITAL INC
  		Employer identification number

56-0619359
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
GASTON MEMORIAL HOSPITAL INC
 
Employer identification number

56-0619359
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
Yes
 
263,852
j
Total. lines 1c through 1i ...................................
263,852
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: ANNUAL DUES WERE PAID TO THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION, OF WHICH $25,112 WAS DETERMINED TO BE EXPENDITURES USED IN LOBBYING ACTIVITIES BY THESE ORGANIZATIONS. AN ADDITIONAL $238,740 IN LEGAL FEES WERE PAID FOR LOBBYING EXPENDITURES.
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
GASTON MEMORIAL HOSPITAL INC
 
Employer identification number

56-0619359
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 6,513    
b Contributions ........      
c Investment earnings or losses ... 966    
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........ 		     
f Administrative expenses .... 480    
g End of year balance ...... 6,999    
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet100.000 %
b
Permanent endowment: SchDMd Bullet  
c
Term endowment: SchDMd Bullet  
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   3,501,129 3,501,129
b Buildings ................   267,380,455 118,189,925 149,190,530
c Leasehold improvements ............        
d Equipment ................   203,864,992 162,915,961 40,949,031
e Other .................   15,957,217 4,688,273 11,268,944
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 204,909,634
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) PREPAID PENSION OBLIGATION 36,084,752
(2) DEFERRED FINANCING COSTS 4,760,905
(3) OTHER RECEIVABLES 3,655,234
(4) 457B PLAN ASSETS 4,342,068
(5) DEFERRED CHARGE - INTEREST RATE SWAP 17,125,718




Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 65,968,677
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes  
457B PLAN LIABILITY 4,342,068
ESTIMATED 3RD PARTY SETTLEMENTS 32,804,817
CAPITAL LEASE OBLIGATION 1,792
INTEREST RATE SWAP LIABILITY 17,125,718





Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 54,274,395
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 410,915,293
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 378,093,485
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 32,821,808
4 Net unrealized gains (losses) on investments .......................... 4 -47
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8 -17,921,425
9 Total adjustments (net). Add lines 4 - 8 ............................. 9 -17,921,472
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 14,900,336
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 368,966,543
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a -47
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d -41,948,703
e Add lines 2a through 2d ..................... 2e -41,948,750
3 Subtract line 2e from line 1..................... 3 410,915,293
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c 0
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5 410,915,293
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 336,144,782
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d...................... 2e 0
3 Subtract line 2e from line 1..................... 3 336,144,782
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b 41,948,703
c Add lines 4a and 4b....................... 4c 41,948,703
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5 378,093,485
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNDS ARE USED FOR ONCOLOGY MEDICATIONS.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE SYSTEM IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE SYSTEM HAS DETERMINED THAT IT DOES NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF JUNE 30, 2011 AND 2010, RESPECTIVELY.
PART XI, LINE 8 - OTHER ADJUSTMENTS:   EQUITY TRANSFER -17,921,425.
PART XII, LINE 2D - OTHER ADJUSTMENTS:   BAD DEBT -40,115,744. SWAP INTEREST EXPENSE -1,832,959.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:   BAD DEBT 40,115,744. SWAP INTEREST EXPENSE 1,832,959.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
GASTON MEMORIAL HOSPITAL INC
 
Employer identification number

56-0619359
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
Yes
 
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) .. 		    13,811,326   13,811,326 4.090 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		    61,404,820 51,517,409 9,887,411 2.930 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....     822,409 694,576 127,833 0.040 %
dTotal Charity Care and
Means-Tested Government Programs ..... 		    76,038,555 52,211,985 23,826,570 7.060 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    2,283,238 5,000 2,278,238 0.670 %
f Health professions education
(from Worksheet 5) .. 		    3,171,427   3,171,427 0.940 %
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)            
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		    597,214   597,214 0.180 %
jTotal Other Benefits ...     6,051,879 5,000 6,046,879 1.790 %
kTotal. Add lines 7d and 7j. ..     82,090,434 52,216,985 29,873,449 8.850 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development     1,898,904   1,898,904 0.560 %
9 Other            
10 Total     1,898,904   1,898,904 0.560 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense (at cost).....
2
12,531,533
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
1,083,546
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
126,962,175
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
109,077,053
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
17,885,122
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
Yes
 
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 GASTON MEMORIAL HOSPITAL INCORPORATED
2525 COURT DRIVE
GASTONIA,NC28054 		X X         X   4 DIAGNOSTIC IMAGING CENTERS AND 6 OP SERIVCE CENTER
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:GASTON MEMORIAL HOSPITAL INC
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 7
Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?  
Name and address Type of Facility (Describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
    PART I, LINE 3C: REGARDLESS OF INCOME, ASSETS ARE ALSO USED TO DETERMINE IF A PATIENT QUALIFIES FOR CHARITY. BELOW IS THE VERBIAGE FROM THIS POLICY:EXEMPT ASSETSTHE PRIMARY RESIDENCE ON UP TO (1) ACRE OF LAND, ONE AUTOMOBILE FOR EACH WORKING AGED ADULT, AND OTHER ASSETS, INCLUDING BUT NOT LIMITED TO, RETIREMENT FUNDS, INVESTMENTS AND OTHER FINANCIAL ASSETS, CASH VALUE OF LIFE INSURANCE POLICIES, AND EQUITY IN PROPERTY OR REAL ASSETS, TOTALING UP TO $25,000 ARE EXEMPT FROM CONSIDERATION AS ASSETS IN DETERMINING CHARITY CARE ELIGIBILITY. ANNUAL INCOME FROM PROPERTY OF REAL ASSETS WILL BE DEDUCTED FROM THE AMOUNT OF EQUITY IN THE ASSET WHEN CALCULATING THE EXEMPTION.
    PART I, LINE 7: THE COSTING METHODOLOGY USED IS A COST ACCOUNTING SYSTEM. ALL PATIENT SEGMENTS ARE INCLUDED. THIS SYSTEM ASSIGNS DIRECT COSTS TO SUPPLIES, PROCEDURES, ROUTINE AND SPECIALTY ROOM RATES BASED ON THE DEPARTMENT OF ORIGINATION. FIXED COSTS ARE ALLOCATED BASED ON STATISTICAL BASIS. THESE COSTS ARE THEN AGGREGATED AT THE PATIENT LEVEL AND TABULATED BY PAYOR TYPE. NO COST TO CHARGE RATIOS WERE USED IN THE CALCULATIONS.
    PART I, LINE 7G: THESE COSTS DO NOT INCLUDE ANY AMOUNTS ASSOCIATED WITH A PHYSICIAN'S CLINIC.
    PART I, L7 COL(F): $40,115,744 BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES PRIOR TO CALCULATING PERCENT OF TOTAL EXPENSE.
    PART II: WORKFORCE DEVELOPMENT - CAROMONT HEALTH'S RECRUITMENT OF PHYSICIANS INTO THE FIVE COUNTIES THE SYSTEM SERVES IS DRIVEN BY THE CHANGING LANDSCAPE OF HEALTHCARE REFORM. THE SYSTEM RECRUITS BASED ON IDENTIFIED COMMUNITY HEALTHCARE NEEDS. THE SYSTEM'S GOAL IS TO BE PRO-ACTIVE AND ANTICIPATORY SO THAT THE HEALTHCARE NEEDS OF THE COMMUNITY ARE MET IN A QUALITY DRIVEN AND CONVENIENT MANNER.
    PART III, LINE 4: THE SYSTEM DESCRIBED IN PART 1 LINE 7 WAS USED FOR PART III LINE 2. TOTAL CHARGES AND THE CHARGES WRITTEN OFF TO BAD DEBT WERE TABULATED AT THE PATIENT LEVEL. THE DETAILED COST OF THE PATIENT WAS MULTIPLIED BY THE RATIO OF CHARGES WRITTEN OFF/TOTAL CHARGES PER PATIENT TO ASSIGN THE COST TO THE PATIENT. BECAUSE OF THIS COST BASED METHOD, DISCOUNTS AND PAYMENTS WOULD BE THE DIFFERENCE BETWEEN THE TOTAL CHARGES AND THE CHARGES WRITTEN OFF TO BAD DEBT.RATIONALE FOR PART III, LINE 3: CHARGES FOR SERVICES PROVIDED IN THE EMERGENCY DEPT ARE EVALUATED FOR CHARITY BASED ON MEANS TESTING. CHARGES FOR SERVICES PROVIDED ELSEWHERE IN THE HOSPITAL ARE EVALUATED FOR CHARITY BASED ON APPLICATIONS FILED BY PATIENTS. IF NO APPLICATION IS FILED, THE UNPAID AMOUNT IS WRITTEN-OFF TO BAD DEBT. THE % OF PATIENTS QUALIFYING FOR CHARITY IN THE EMERGENCY DEPT WAS APPLIED TO THE REMAINDER OF THE HOSPITAL TO DETERMINE THE % OF BAD DEBT PATIENTS WHO COULD HAVE BEEN CHARITY. THE BAD DEBT WRITE-OFFS WERE CONVERTED TO COST USING THE METHODOLOGIES DESCRIBED ABOVE.THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE ON BAD DEBT EXPENSE. BAD DEBT EXPENSE IS REPORTED AS A DEDUCTION FROM PATIENT REVENUE.
    PART III, LINE 8: THE MEDICARE COST REPORT STANDARD COSTING METHODOLOGY WAS FOLLOWED WHEN FILING THE COST REPORT. THIS IS A STEP DOWN METHODOLOGY THAT APPLIES THE AVERAGE PATIENT COST TO MEDICARE PATIENTS. THE COST REPORT ALSO DOES NOT ALLOW HOSPITALS TO REPORT ALL OPERATING COSTS. BECAUSE OF THESE TWO ISSUES, THE MEDICARE COST REPORT METHODOLOGY UNDERSTATES THE TRUE COST OF TREATING MEDICARE PATIENTS.
    PART III, LINE 9B: THE POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. BELOW IS VERBIAGE FROM THE CHARITY POLICY:GASTON MEMORIAL HOSPITAL OFFERS MEDICAL SERVICES FREE OR AT A REDUCED RATE THROUGH THE CHARITY CARE PROGRAM. DETERMINATION OF FULL OR PARTIAL CHARITY CARE WILL BE BASED ON THE PATIENT'S INCOME, FAMILY SIZE, AND ASSETS. POTENTIAL ELIGIBILITY EXISTS ONLY AFTER REIMBURSEMENT EFFORTS FROM ALL OTHER THIRD PARTY RESOURCES, FEDERAL, STATE, AND LOCAL ASSISTANCE PROGRAMS HAVE BEEN EXHAUSTED.
    PART I, LINE 6A: THE ORGANIZATION COMMUNITY BENEFIT REPORT MADE AVAILABLE TO THE PUBLIC CONTAINS COMMUNITY BENEFITS FOR ALL RELATED ORGANIZATIONS TO THE HOSPITAL.
    PART VI, LINE 2: CAROMONT HEALTH ESTABLISHES COMMUNITY PRIORITIES THROUGH A NUMBER OF MECHANISMS:- LEADERSHIP OPINIONS ARE SOUGHT TO HELP IDENTIFY NEEDED SERVICES IN THE COMMUNITY. TELEPHONE SURVEYS ARE CONDUCTED ON A PERIODIC BASIS TO GATHER OPINIONS FROM RESIDENTS IN THE SERVICE AREA; THE MOST RECENT STUDY WAS COMPLETED IN THE SPRING OF 2009.- PATIENT SATISFACTION DATA IS ANALYZED TO DETERMINE WHERE AND/OR HOW SERVICES NEED TO BE IMPROVED.- SERVICE AREA DATA (VITAL STATISTICS, DEMOGRAPHICS AND UTILIZATION) ARE ANALYZED FOR TRENDS. THIS INFORMATION IS COORDINATED WITH PUBLIC HEALTH DATA TO DETERMINE VOIDS AND SERVICE AREA HEALTH PROBLEMS.- FINDINGS FROM COMMUNITY SURVEYS/REPORTS PUBLISHED BY OTHER ORGANIZATIONS (UNITED WAY, CHAMBER OF COMMERCE, PARTNERSHIP FOR CHILDREN, GASTON COUNTY, ETC.) ARE GATHERED AND REVIEWED FOR PERTINENCE TO COMMUNITY HEALTH PROBLEMS.- GASTON MEMORIAL HOSPITAL THROUGH THE GCHC IN CONJUNCTION WITH THE GASTON COUNTY HEALTH DEPARTMENT CONDUCTS A COMMUNITY ASSESSMENT EVERY FOUR YEARS. THE MOST RECENT STUDY WAS FALL, 2008. THIS ASSESSMENT GATHERS OPINIONS AND IS COMBINED WITH PUBLIC HEALTH DATA TO DETERMINE THE TOP FOUR COMMUNITY-WIDE HEALTH ISSUES. SERVICE AREA STRENGTHS, WEAKNESSES AND OPPORTUNITIES ARE USED AS A BASIS FOR ESTABLISHING COMMUNITY PRIORITIES. ALL THIS INFORMATION IS USED TO ESTABLISH ORGANIZATIONAL PRIORITIES, IDENTIFY AGENCIES AND ORGANIZATIONS TO BE INVOLVED IN RESOLVING COMMUNITY ISSUES, AND IMPLEMENT PROGRAMS TO RESOLVE IDENTIFIED ISSUES. GOALS, OBJECTIVES AND STRATEGIES ARE ESTABLISHED AND THE PROGRESS IS EVALUATED ON AN ANNUAL BASIS.- BOARD MEMBERS, SENIOR MANAGEMENT AND DEPARTMENT DIRECTORS ARE INVOLVED IN NUMEROUS ORGANIZATIONS. THROUGH THIS NETWORK OF RELATIONSHIPS, FURTHER INFORMATION ABOUT THE COMMUNITY AND THE NEEDS OF AREA RESIDENTS AND ORGANIZATIONS ARE USED IN THE DEVELOPMENT OF PROGRAMS AND SERVICES AVAILABLE THOUGH CAROMONT HEALTH.
    PART VI, LINE 3: PATIENTS ARE NOTIFIED IN SEVERAL WAYS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE. BROCHURES ARE DISTRIBUTED AND VERBAL COMMUNICATION BETWEEN STAFF AND PATIENT IS PROACTIVE. IN ADDITION, THE HOSPITAL HAS HIRED STAFF TO ASSIST UNINSURED AND UNDERINSURED PATIENTS WITH ENROLLMENT IN VARIOUS PUBLIC PROGRAMS, INCLUDING MEDICAID.
    PART VI, LINE 4: GASTON COUNTY, WHICH IS THE COUNTY LOCATED TO THE WEST OF THE CHARLOTTE NC, IS THE HOSPITAL'S PRIMARY MARKET. LINCOLN, CLEVELAND, AND MECKLENBURG COUNTIES ARE THE HOSPITAL'S SECONDARY MARKET. THERE ARE NO OTHER ACUTE CARE HOSPITALS IN THE PRIMARY SERVICE AREA. ACCORDING TO THE U.S. CENSUS BUREAU, GASTON COUNTY HAD A POPULATION OF 206,086 (2010), A MEDIAN HOUSEHOLD INCOME OF $43,253 (2006-2010), AND 16.6% PERSONS BELOW POVERTY LEVEL (2006-2010). DURING FISCAL YEAR 2011, 8% OF THE HOSPITAL'S GROSS CHARGES WERE FROM UNINSURED PATIENTS AND 17% WAS FROM MEDICAID PATIENTS.
    PART VI, LINE 6: STEPS TOWARDS ACCOUNTABLE CARETHE INSTITUTE FOR HEALTHCARE IMPROVEMENT HAS ESTABLISHED A TRIO OF OBJECTIVES CALLED THE TRIPLE AIM, WHICH CAROMONT HEALTH HAS ADOPTED: - IMPROVE THE HEALTH OF THE POPULATION - ENHANCE THE PATIENT EXPERIENCE (QUALITY, ACCESS, RELIABILITY) - CONTROL COSTSTHESE THREE OBJECTIVES ARE ALL CRITICAL COMPONENTS IN BEING WHAT IS KNOWN IN THE INDUSTRY AS AN ACCOUNTABLE CARE ORGANIZATION (ACO). IN OUR STEPS TOWARD BECOMING AN ACO, CAROMONT HEALTH IS UNDERTAKING CHANGES THAT WILL LEAD TO BETTER COORDINATED CARE WITH BETTER OUTCOMES AT LOWER COSTS FOR PATIENTS. WE ARE ALSO EMBRACING THE "MEDICAL HOME" CONCEPT, WHICH IS A NATIONAL INITIATIVE DESIGNED TO IMPROVE HEALTH CARE QUALITY. MEDICAL HOMES ARE PATIENT CENTERED, TEAM-BASED APPROACHES TO CARE THAT HAVE BEEN SHOWN TO REDUCE HOSPITAL ADMISSIONS AND DECREASE COSTS. COMMUNITY HEALTHOUR COMMUNITY HEALTH INITIATIVES ARE FOCUSED PRIMARILY ON DISEASE PREVENTION AND BETTER MANAGEMENT OF CHRONIC ILLNESSES. THAT INCLUDES WORKING WITH LOCAL EMPLOYERS ON INNOVATIVE PROGRAMS AND COLLABORATING WITH OUR HEALTH CARE NEIGHBORS. THROUGH INNOVATION AND A FOCUS ON COMMUNITY WELLNESS, CAROMONT HEALTH IS DETERMINED TO MAKE UPCOMING CHANGES IN HEALTHCARE TO HAVE A POSITIVE IMPACT ON THE PEOPLE WE SERVE. TOBACCO CESSATION PROGRAMIN ORDER TO PROVIDE A HEALTHY ENVIRONMENT FOR OUR PATIENTS, FAMILIES AND STAFF, CAROMONT HEALTH AND ITS AFFILIATE CAMPUSES HAVE BEEN TOBACCO-FREE SINCE JANUARY 2007. IN FEBRUARY 2011, CAROMONT RECEIVED THE "GOLD STAR STANDARD HOSPITALS" DESIGNATION FROM NORTH CAROLINA PREVENTION PARTNERS FOR EXCELLENCE IN OUR EMPLOYEE TOBACCO CESSATION PROGRAMS. ALL EMPLOYEES WHO USE TOBACCO MAY PARTICIPATE IN A "QUIT PROGRAM", WHICH PROVIDES THEM WITH INCENTIVES IF THEY QUIT USING TOBACCO AND REMAIN TOBACCO-FREE FOR AT LEAST SIX MONTHS.GASTON COUNTY HEALTH SUMMITCAROMONT HEALTH HOSTED A HIGH PROFILE, PUBLIC CONVERSATION ABOUT THE HEALTH OF OUR COMMUNITY DURING THE 2011 GASTON COUNTY HEALTH SUMMIT, WHICH WAS HELD IN LATE MARCH. THE EVENT BROUGHT TOGETHER LEADERS FROM ORGANIZATIONS AND BUSINESSES SUCH AS CAROMONT HEALTH, COMMUNITY HEALTH PARTNERS, GASTON COMMUNITY HEALTHCARE COMMISSION, GASTON COUNTY DEPARTMENT OF SOCIAL SERVICES, GASTON COUNTY HEALTH DEPARTMENT, GASTON FAMILY HEALTH SERVICES, PATHWAYS, PHARR YARNS AND THE YMCA. ATTENDEES DISCUSSED WHERE OUR COMMUNITY STANDS IN TERMS OF HEALTH, INCLUDING WAYS TO IMPROVE HEALTH AND THE RELATIONSHIP BETWEEN BUSINESSES AND A COMMUNITY'S HEALTHCARE PROVIDERS. THE GASTON COUNTY HEALTH COALITION'S GOAL IS TO IMPROVE THE HEALTH STATUS OF OUR COMMUNITY, PARTICULARLY IN TERMS OF CHRONIC DISEASE MANAGEMENT. COMMUNITY CONVERSATIONS SUCH AS THE GASTON COUNTY HEALTH SUMMIT ARE HELPING DIVERSE GROUPS WORK TOGETHER TO MEET THOSE GOALS.HEALTHNET GASTONHEALTHNET GASTON (HNG) IS A PROGRAM DESIGNED TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO LOW-INCOME, UNINSURED RESIDENTS OF GASTON COUNTY. ITS SERVICES INCLUDE: A MEDICAL HOME/PRIMARY CARE PHYSICIAN SERVICES, SPECIALTY PHYSICIAN SERVICES, MEDICATION ASSISTANCE, CASE MANAGEMENT/HEALTH COACHING ACTIVITIES, AND HOSPITAL SERVICES. HNG OPERATES THROUGH THE LEADERSHIP AND COLLABORATION OF ITS FOUR FOUNDING STRATEGIC PARTNERS, INCLUDING: GASTON MEMORIAL HOSPITAL, GASTON FAMILY HEALTH SERVICES, COMMUNITY HEALTH PARTNERS, GASTON COMMUNITY HEALTH CARE COMMISSION. OTHER STRATEGIC PARTNERS INVOLVED WITH THIS INITIATIVE INCLUDE COMMUNITY 241 PHYSICIANS, GASTON COUNTY DEPARTMENT OF SOCIAL SERVICES, GASTON COUNTY HEALTH DEPARTMENT, AND OTHER LOCAL LEADERS.COMMUNITY HEALTH IMPROVEMENT ADVOCACYCAROMONT HEALTH HAS SIGNIFICANTLY IMPACTED ITS COMMUNITY IN PROVIDING MANY DIFFERENT HEALTH IMPROVEMENT PROJECTS, GROUPS, EVENTS, EDUCATION PROGRAMS, ETC.
    PART VI, LINE 7: CAROMONT HEALTH IN GASTONIA, NORTH CAROLINA IS A REGIONAL, INDEPENDENT, NOT-FOR-PROFIT HEALTH CARE SYSTEM. IT ENCOMPASSES GASTON MEMORIAL HOSPITAL WITH 435-BEDS; COURTLAND TERRACE, A 96-BED SKILLED NURSING FACILITY; GASTON HOSPICE WHICH INCLUDES THE 12-BED ROBIN JOHNSON HOUSE INPATIENT FACILITY, AND CAROMONT MEDICAL GROUP, A NETWORK OF 44 PRIMARY AND SPECIALTY PHYSICIAN OFFICES. CAROMONT HEALTH'S VISION IS TO BE A NATIONALLY RECOGNIZED LEADER AND VALUED PARTNER IN PROMOTING INDIVIDUAL HEALTH AND VIBRANT COMMUNITIES.COURTLAND TERRACE IS A 96-BED SKILLED NURSING FACILITY.GASTON HOSPICE HOSTS THE 12 BED ROBIN JOHNSON HOUSE INPATIENT FACILITY.CAROMONT MEDICAL GROUP IS A NETWORK OF 45 PRIMARY AND SPECIALTY PHYSICIAN OFFICES IN 5 COUNTIES AND IN 2 STATES.CAROMONT HEALTH HAS 3 OFF-SITE IMAGING LOCATIONS, 2 SAME-DAY SURGERY CENTERS AND 1 OCCUPATIONAL MEDICINE CLINIC.THE GASTON MEMORIAL HOSPITAL FOUNDATION (A SUBSIDIARY OF CAROMONT HEALTH) WAS ESTABLISHED IN 1985. IN ADDITION TO THE FOUNDATION UTILIZING ITS INVESTMENT EARNINGS FOR DONATIONS, CAROMONT HEALTH DONATES UP TO 10% OF ITS OPERATING INCOME TO THE GMH FOUNDATION EACH YEAR.DURING FISCAL YEAR 2011, OVER $700,000 IN DONATIONS WERE DISTRIBUTED TO CHARITABLE CAUSES THROUGHOUT GASTON COUNTY. FUNDS WERE GIVEN FOR THE FOLLOWING ORGANIZATIONS:GASTON FAMILY HEALTH SERVICES, GASTON TOGETHER, HEALTH NET GASTON, UNITED WAY, ALLIANCE CHILD/YOUTH. IN ADDITION, FOUNDATION GRANTS WERE PROVIDED TO FOR THE FOLLOWING: INDIGENT MEDICATIONS TRANSITIONAL CARE, GREAT 100, AND WAYNE F. SHOVELIN SCHOLARSHIP.
REPORTS FILED WITH STATES PART VI, LINE 7 NC
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
GASTON MEMORIAL HOSPITAL INC
 
Employer identification number
56-0619359
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) CATAWBA LANDS CONSERVANCY105 W MOREHEAD STREET
CHARLOTTE,NC28232 		58-1969605 501(C)(3) 5,000   FMV   COMMUNITY ASSISTANCE
(2) CHARLOTTE CHAMBER OF COMMERCEPO BOX 32785
CHARLOTTE,NC28232 		56-0173610 501(C)(3) 10,000   FMV   COMMUNITY ASSISTANCE
(3) UNITED WAY OF GASTON COUNTY200 EAST FRANKLIN BLVD
GASTONIA,NC28052 		56-0653356 501(C)(3) 7,590   FMV   COMMUNITY ASSISTANCE
(4) COMMUNITY FOUNDATION OF GASTON COUNTY1201 E GARRISON BLVD
GASTONIA,NC28053 		58-1340834 501(C)(3) 22,500   FMV   COMMUNITY ASSISTANCE
(5) CRAMERTON POLICE DEPT155 NORTH MAIN ST
CRAMERTON,NC28032 		58-0891982 GOVERNMENTAL 22,842   FMV   COMMUNITY ASSISTANCE
(6) DANIEL STOWE GARDENS6500 SOUTH NEW HOPE ROAD
BELMONT,NC28012 		20-8362933 501(C)(3) 20,000   FMV   COMMUNITY ASSISTANCE
(7) GASTON ARTS COUNCILPO BOX 242
GASTONIA,NC28053 		56-1257449 501(C)(3) 6,000   FMV   COMMUNITY ASSISTANCE
(8) GASTON COLLEGE FOUNDATION201 HIGHWAY 321 SOUTH
DALLAS,NC28034 		23-7079454 501(C)(3) 5,000   FMV   COMMUNITY ASSISTANCE
(9) GASTON COUNTY SCHOOLS943 OSCEOLA STREET
GASTONIA,NC28053 		56-6001032 GOVERNMENTAL 10,000   FMV   COMMUNITY ASSISTANCE
(10) GASTON GAZETTEPO BOX 1538
GASTONIA,NC28053 		58-0904885 N/A 6,750   FMV   COMMUNITY ASSISTANCE
(11) GASTON HOSPICE258 E GARRISON BLVD
GASTONIA,NC28054 		58-1341530 501(C)(3) 5,000   FMV   COMMUNITY ASSISTANCE
(12) GASTON REGIONAL CHAMBER601 W FRANKLIN BLVD
GASTONIA,NC28053 		56-0232990 GOVERNMENTAL 32,275   FMV   COMMUNITY ASSISTANCE
(13) GASTONIA GRIZZLIESPO BOX 177
GASTONIA,NC28053 		42-1554288 501(C)(3) 7,000   FMV   COMMUNITY ASSISTANCE
(14) HEALTHCORPS FOUNDATION191 7TH AVE
NEW YORK,NY10011 		26-1269358 501(C)(3) 10,000   FMV   COMMUNITY ASSISTANCE
(15) HOLY ANGELS FOUNDATION6600 WILKINSON BLVD
BELMONT,NC28012 		56-1762654 501(C)(3) 10,150   FMV   COMMUNITY ASSISTANCE
(16) MOUNT HOLLY FARMER'S MKT120 OAKLAND STREET
MT HOLLY,NC28120 		26-0464156 N/A 5,000   FMV   COMMUNITY ASSISTANCE
(17) MOUNT HOLLYDAYSPO BOX 787
MT HOLLY,NC28120 		26-2310697 501(C)(3) 12,000   FMV   COMMUNITY ASSISTANCE
(18) NC PREVENTION PARTNERS88 VILCOM CIRCLE
CHAPEL HILL,NC27514 		31-1722051 501(C)(3) 5,000   FMV   COMMUNITY ASSISTANCE
(19) NC PHYSICIANS HEALTH PROGRAM220 HORIZON DRIVE SUITE 201
RALEIGH,NC27615 		56-1846599 501(C)(3) 5,500   FMV   COMMUNITY ASSISTANCE
(20) THE MINT MUSEUM500 S TRYON STREET
CHARLOTTE,NC28202 		56-0670666 501(C)(3) 10,000   FMV   COMMUNITY ASSISTANCE
2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
18
3
Enter total number of other organizations ................................ . Bullet Image
2
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: OTHER ORGANIZATIONS THAT RECEIVE GRANT FUNDS MAY BE REQUIRED TO SUBMIT MONTHLY REPORTS THAT ARE MONITORED BY MANAGEMENT AND/OR THE BOARD OF DIRECTORS. ALL GRANTS DECISIONS ARE DOCUMENTED.
Schedule I (Form 990) 2010


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
GASTON MEMORIAL HOSPITAL INC
 
Employer identification number

56-0619359
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
Yes
 
b
Any related organization? .........................
6b
Yes
 
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) KELVIN C HARRIS MD (i)
(ii)		 0
161,344 		0
69,928 		0
404 		0
5,100 		0
12,661 		0
249,437 		0
0
(2) VALINDA L RUTLEDGE (i)
(ii)		 577,086
0 		316,937
0 		182,402
0 		3,613
0 		35,021
0 		1,115,059
0 		30,281
0
(3) DAVID O'CONNOR (i)
(ii)		 322,191
0 		135,109
0 		235,272
0 		7,350
0 		32,470
0 		732,392
0 		81,255
0
(4) MARIA LONG (i)
(ii)		 240,185
0 		107,347
0 		140,056
0 		7,350
0 		26,304
0 		521,242
0 		54,573
0
(5) JAMES D HUBER (i)
(ii)		 274,883
0 		140,994
0 		111,679
0 		7,211
0 		17,356
0 		552,123
0 		70,783
0
(6) STEVEN A RUBIN (i)
(ii)		 217,271
0 		94,066
0 		150,466
0 		6,796
0 		41,711
0 		510,310
0 		56,875
0
(7) TERRY L JONES (i)
(ii)		 341,070
0 		325,548
0 		149,659
0 		7,350
0 		83,250
0 		906,877
0 		82,864
0
(8) W K HARWELL (i)
(ii)		 221,202
0 		96,137
0 		128,673
0 		6,724
0 		132,983
0 		585,719
0 		55,017
0
(9) ANDREA K SERRA (i)
(ii)		 184,674
0 		75,521
0 		125,430
0 		5,614
0 		40,418
0 		431,657
0 		48,208
0
(10) MICHAEL R JOHNSON (i)
(ii)		 230,017
0 		45,810
0 		13,014
0 		7,108
0 		54,284
0 		350,233
0 		0
0
(11) ROWENA BUFFETT TIMMS (i)
(ii)		 166,689
0 		61,153
0 		78,193
0 		0
0 		17,060
0 		323,095
0 		0
0
(12) KATHLEEN L BESSON (i)
(ii)		 198,430
0 		39,191
0 		39,055
0 		5,953
0 		38,111
0 		320,740
0 		0
0
(13) WAYNE F SHOVELIN (i)
(ii)		 0
0 		0
0 		5,914,978
0 		0
0 		0
0 		5,914,978
0 		472,568
0



Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
  PART I, LINE 1A TRAVEL FOR COMPANIONS - IF A SPOUSE OR COMPANION IS EXPECTED TO ATTEND AN EVENT, IT MUST BE APPROVED IN ADVANCE AND THE EXPENSES OF THE SPOUSE OR COMPANION WILL BE TREATED AS TAXABLE COMPENSATION AND ADDED TO THE EMPLOYEE'S W2 OR A 1099 WILL BE ISSUED AT THE END OF THE CALENDAR YEAR. DURING FY 2011 THIS BENEFIT WAS PROVIDED TO THE CEO AND SOME BOARD MEMBERS. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS - REIMBURSEMENT FOR CERTAIN TAXABLE BENEFIT COSTS (I.E. CELL PHONES) WILL BE GROSSED UP FOR ANY TAX OBLIGATIONS. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES - A PERCENTAGE OF PERSONAL USE OF DUES PAYMENTS FOR MEMBERSHIP IN A HEALTH OR FITNESS CLUB OR A SOCIAL OR RECREATIONAL CLUB WILL BE ADDED TO THE EMPLOYEE'S W-2 AT THE END OF THE CALENDAR YEAR. DURING FY 2011 THIS BENEFIT WAS PROVIDED TO THE CEO AND CFO.
  PART I, LINES 4A-B WAYNE F. SHOVELIN, FORMER CEO PARTICIPATED IN A SUPPLEMENTAL SALARY CONTINUATION RETIREMENT PLAN. GROSS PAYMENTS FOR 2010 WERE $5,914,978. PLEASE REFER TO THE SCHEDULE O DISCLOSURE FOR PART VI, SECTION B, LINE 15 FOR MORE DETAIL.
  PART I, LINE 6 CERTAIN CAROMONT MEDICAL GROUP INC. PHYSICIAN'S COMPENSATION PACKAGES ARE BASED ON THE INDIVIDUAL PHYSICIAN'S NET RESULTS FROM OPERATIONS AS CALCULATED BASED SOLEY ON HIS/HER NET CHARGES LESS HIS/HER ALLOCABLE SHARE OF CLINIC OVERHEAD COSTS. EXECUTIVE INCENTIVE COMPENSATION PLAN FOR ALL KEY EMPLOYEES BASED ON THE ACHIEVEMENT OF ANNUAL BUSINESS OBJECTIVES AND FINANCIAL PERFORMANCE OF THE CONSOLIDATED SYSTEM. MANAGER INCENTIVE PLAN BASED ON CONSOLIDATED CORPORATE AND INDIVIDUAL PERFORMANCE GOALS.
Schedule J (Form 990) 2010

Additional Data


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Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
GASTON MEMORIAL HOSPITAL INC
 
Employer identification number
56-0619359
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A NORTH CAROLINA MEDICAL CARE COMMISSION
  		52-1309402 65820HVF7 01-23-2003 120,000,000 PLEASE SEE SUPPLEMENTAL INFORMATION   X   X   X
B NORTH CAROLINA MEDICAL CARE COMMISSION
  		52-1309402 65820HG64 01-01-2008 118,400,000 PLEASE SEE SUPPLEMENTAL INFORMATION   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired. . . . . 700,000 18,190,000    
2 Amount of bonds defeased . . . .        
3 Total proceeds of issue . . . . 123,222,025 118,629,570    
4 Gross proceeds in reserve funds . .        
5 Capitalized interest from proceeds. 5,150,936 610,174    
6 Proceeds in refunding escrow. . . . .        
7 Issuance costs from proceeds . . . 1,256,069 917,471    
8 Credit enhancement from proceeds. 3,386,000 1,553,717    
9 Working capital expenditures from proceeds . .        
10 Capital expenditures from proceeds . . 91,583,999 28,947,486    
11 Other spent proceeds . . 21,845,020 86,600,722    
12 Other unspent proceeds. . .        
13 Year of substantial completion . . . 2005 2009
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue?   X X          
15 Were the bonds issued as part of an advance refunding issue? X     X        
16 Has the final allocation of proceeds been made? . . X   X          
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . X   X          
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .   X   X        
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .   X   X        
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2010
Schedule K (Form 990) 2010
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use? X   X          
b Are there any research agreements that may result in private business use of bond-financed property? . .   X   X        
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? . X   X          
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . . SchKMediumBullet 0 % 0 %    
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . SchKMediumBullet 0 % 0 %    
6 Total of lines 4 and 5 . . .. . . . . . 0 % 0 %    
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities? X   X          
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X        
2 Is the bond issue a variable rate issue? X   X          
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue? X   X          
b Name of provider . MERRILL LYNCH
CAPITAL SERVICES 		MERRILL LYNCH
DERIVATIVE PRODUCTS 		 
  		 
 
c Term of hedge . . 31.600000000000 21.000000000000    
d Was the hedge superintegrated? .   X   X        
e Was a hedge terminated? .   X   X        
4a Were gross proceeds invested in a GIC? .   X   X        
b Name of provider .  
  		 
  		 
  		 
 
c Term of GIC . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .                
5 Were any gross proceeds invested beyond an available temporary period? .   X   X        
6 Did the bond issue qualify for an exception to rebate? . . .   X X          
Schedule K (Form 990) 2010

Schedule K (Form 990) 2010
Page 3
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
SCHEDULE K SUPPLENTAL INFORMATION   THREE 501(C)(3) ORGANIZATIONS WITHIN THE PARENT-SUBSIDIARY CONTROLLED GROUP BENEFIT FROM THE BONDS AS FOLLOWS: GASTON MEMORIAL HOSPITAL, INC. (56-0619359); CAROMONT HEALTH, INC. (58-1636959); CAROMONT HEALTH SERVICES, INC. (56-1455630). GASTON MEMORIAL HOSPITAL, INC. HOLDS THE LIABILITY FOR THE BONDS, PER AUDITED FINANCIAL STATEMENTS.
PART I, LINE A, COLUMN C   THIS BOND ISSUE INCLUDES TWO CUSIPS MATURING ON THE SAME DATE: 65820HVG5 AND 65820HVF7
PART I, COLUMN (F) DESCRIPTION OF PURPOSE ISSUE A - NEW CONSTRUCTION OF HOSPITAL FACILITIES, PURCHASE OF HOSPITAL EQUIPMENT, PARTIAL REFUNDING OF SERIES 1998 BONDS ISSUED ON AUGUST 27,1998 ISSUE B - RENOVATION OF HOSPITAL FACILITIES, PURCHASE OF HOSPITAL EQUIPMENT, REFUNDING OF ENTIRE SERIES 1995 BONDS ISSUED ON NOVEMBER 15, 1995, REFUNDING OF ENTIRE SERIES 1998 BONDS ISSUED ON AUGUST 27, 1998
PART II, LINE 11   OTHER SPENT PROCEEDS WERE DEPOSITS MADE INTO A REFUNDING ESCROW ACCOUNT ALONG WITH INTEREST EARNED ON THE ACCOUNT, BOTH OF WHICH WERE SUBSEQUENTLY USED TO PAY PRINCIPLE AND INTEREST ON THE REFUNDED BONDS.
PART IV, LINES 2 AND 3A, COLUMN B   THE SERIES 2008 BONDS WERE ORIGINALLY ISSUED AS VARIABLE BONDS BEARING INTEREST AT WEEKLY RATES. CAROMONT HEALTH, INC. ENTERED INTO INTEREST SWAP AGREEMENTS TO HEDGE ITS INTEREST RISK WITH RESPECT TO A PORTION OF THE SERIES 2008 BONDS. ON SEPTEMBER 1, 2010, THE SERIES 2008 BONDS WERE CONVERTED TO FIXED INTEREST RATES TO MATURITY. HOWEVER, THE INTEREST RATE SWAPS WERE NOT TERMINATED IN CONNECTION WITH SUCH FIXED RATE CONVERSION AND REMAIN IN EFFECT.
PART IV, LINE 3C, COLUMN B   THIS BOND ISSUE HAS TWO HEDGE TERMS: 11.0 YEARS AND 21.0 YEARS
AMENDED RETURN:   THE 2010 SCHEDULE K WAS AMENDED TO CORRET AN ERROR ON PART II, COLUMM (B), LINE 10. THE AMOUNT IN THE ORIGINAL FILING WAS OVERSTATED BY $1 MILLION. THE AMOUNT HAS BEEN AMENDED TO CORRECTLY STATE THE AMOUNT $28,947,486.
Schedule K (Form 990) 2010

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
GASTON MEMORIAL HOSPITAL INC
 
Employer identification number

56-0619359
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) LUCINDA DAVIS FAMILY MEMBER OF DIRECTOR, JAMES BEAM 54,468 COMPENSATION AS EMPLOYEE   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
GASTON MEMORIAL HOSPITAL INC
 
Employer identification number

56-0619359
Identifier Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 4   THE ORGANIZATION AMENDED ITS BYLAWS WHICH INCLUDED REVISIONS THAT SPECIFICALLY OUTLINE POWERS OF THE PARENT ORGANIZATION AND SOLE MEMBER OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 6   THE SOLE MEMBER OF THE CORPORATION SHALL BE CAROMONT HEALTH, INC., A NORTH CAROLINA NOT-FOR-PROFIT CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7A   THE BOARD OF DIRECTORS SHALL CONSIST OF FOURTEEN (14) MEMBERS, ALL OF WHOM SHALL BE THE MEMBERS OF THE BOARD OF DIRECTORS OF CAROMONT HEALTH, INC., AND ALL OF WHOM SHALL BE APPOINTED BY THE BOARD OF DIRECTORS OF CAROMONT HEALTH.
FORM 990, PART VI, SECTION A, LINE 7B   THE FOLLOWING POWERS OF THE CORPORATION SHALL BE RESERVED TO CAROMONT HEALTH, INC., THE PARENT CORPORATION AND HOLDING COMPANY OF THE CORPORATION: (A) FINANCIAL POWERS, INCLUDING THE POWER TO APPROVE AN OPERATING BUDGET FOR THE CORPORATION, POWER TO APPROVE COMPENSATION PLANS, AND POWER TO ASSUME DEBT ON BEHALF OF THE CORPORATION; (B) GOVERNING POWERS, INCLUDING THE POWER TO APPROVE ALL CHANGES TO THE GOVERNING DOCUMENTS OF THE CORPORATION AND POWER TO APPROVE THE MISSION, VISION AND VALUES OF THE CORPORATION; AND (C) STRATEGIC POWERS, INCLUDING THE POWER TO APPROVE ALL CERTIFICATE OF NEED APPLICATIONS WHICH THE CORPORATION MAY FILE IN ANY STATE, AND THE POWER TO APPROVE ALL SALE OR LEASE TRANSACTIONS OF THE CORPORATION.
FORM 990, PART VI, SECTION B, LINE 11   THE ORGANIZATION'S FORM 990 WAS REVIEWED BY THE AUDIT FINANCE INVESTMENT COMMITTEE OF THE BOARD OF DIRECTORS PRIOR TO PRESENTATION TO THE FULL BOARD BEFORE THE FORM WAS FILED WITH THE IRS.
  FORM 990, PART VI, SECTION B, LINE 12C EACH APPLICABLE EMPLOYEE AND DIRECTOR SHALL FULLY AND TRUTHFULLY COMPLETE A QUESTIONNAIRE CONCERNING POTENTIAL AND ACTUAL CONFLICTS OF INTEREST ANNUALLY. SUCH QUESTIONNAIRE SHALL IDENTIFY THE EMPLOYEE'S OBLIGATION TO IMMEDIATELY MAKE THE PRESIDENT AWARE IN WRITING OF ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST AS THEY MAY ARISE AND CONTAIN SAID EMPLOYEE'S AGREEMENT TO ABIDE BY ALL TERMS AND CONDITIONS OF THIS POLICY AS A CONDITION OF RETAINING THEIR POSITION. SUCH QUESTIONNAIRES SHALL BE REVIEWED ANNUALLY BY THE EXECUTIVE VICE PRESIDENT/GENERAL COUNSEL AND THE CORPORATE RESPONSIBILITY OFFICER.
  FORM 990, PART VI, SECTION B, LINE 15 THE CEO, CFO/ASSISTANT TREASURER AND EVP GENERAL COUNSEL/ASSISTANT SECRETARY ARE COMPENSATED FOR THEIR SERVICES BY GASTON MEMORIAL HOSIPIAL, A SUBSIDIARY OF CAROMONT HEALTH, INC. THE COMPENSATION OF ALL CAROMONT EXECUTIVES FOR EACH YEAR IS ESTABLISHED BY THE COMPENSATION COMMITTEE OF THE CAROMONT HEALTH BOARD OF DIRECTORS, BASED ON GUIDANCE AND OPINIONS PROVIDED BY AN INDEPENDENT, THIRD-PARTY COMPENSATION CONSULTANT. BOARD MEMBERS WHO SERVE ON THE COMPENSATION COMMITTEE ARE INDEPENDENT AND FREE OF ANY CONFLICT OF INTEREST. ANY COMPENSATION COMMITTEE MEMBER WHO DEVELOPS A CONFLICT OF INTEREST DURING HIS/HER TERM WITH RESPECT TO THE DISCUSSION OF ANY EXECUTIVE'S COMPENSATION LEAVES THE MEETING AND DOES NOT PARTICIPATE IN THE DISCUSSION OR DECISION-MAKING BY THE REMAINING INDEPENDENT MEMBERS OF THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE RETAINS JURISDICTION OVER THE TOTAL COMPENSATION PACKAGE FOR EXECUTIVES AND REVIEWS EXECUTIVE BENEFITS AND PERQUISITES AS WELL AS TOTAL CASH COMPENSATION. COMPENSATION FOR THE CEO IS ESTABLISHED THROUGH A PROCESS OF PERFORMANCE EVALUATION, COMPARISON WITH COMPARABLE MARKET DATA AND DETERMINATION BY THE COMPENSATION COMMITTEE OF ACCEPTABLE SALARY RANGE AND PERCENTILE RANKING. ALL COMPENSATION DECISIONS FOR THE CEO ARE RECOMMENDED BY THE COMPENSATION COMMITTEE AND APPROVED BY THE BOARD OF DIRECTORS. COMPENSATION FOR ALL OTHER EXECUTIVES IS ESTABLISHED THROUGH PERFORMANCE EVALUATION, COMPARISON WITH COMPARABLE MARKET DATA AND DETERMINATION BY THE CEO OF ACCEPTABLE SALARY RANGE AND PERCENTILE RANKING. ALL COMPENSATION DECISIONS FOR EXECUTIVES ARE RECOMMENDED BY THE CEO AND APPROVED BY THE COMPENSATION COMMITTEE. FULL COLLECTED COMPENSATION INFORMATION AND ANY COMPENSATION OPINIONS PROVIDED DURING THESE PROCESSES WILL BE KEPT WITH THE COMPENSATION COMMITTEE OR BOARD MINUTES, AS APPLICABLE. IN 2009, THE BOARD OF DIRECTORS, BY AND THROUGH THE COMPENSATION COMMITTEE, CONDUCTED TWO DETAILED REVIEWS OF THE RETIREMENT BENEFIT TO BE PAID TO ITS RETIRING CEO. IN CONDUCTING THESE REVIEWS, THE COMPENSATION COMMITTEE WORKED THROUGH AN EVALUATION OF THE RETIRING CEO'S PERFORMANCE DURING HIS 33-YEAR TENURE WITH THE ORGANIZATION. THE COMPENSATION COMMITTEE CONCLUDED THAT IN THE AREAS OF FINANCE AND QUALITY MEASURES, THE RETIRING CEO'S PERFORMANCE CONSISTENTLY EXCEEDED EXPECTATIONS AND HAS POSITIONED CAROMONT HEALTH AS A LEADER IN THE REGION. HIS PERFORMANCE IN THE AREA OF PATIENT SATISFACTION HAS, IN THE MISSION-CRITICAL AREA OF EMERGENCY SERVICES, EXCEEDED THE BOARD OF DIRECTOR'S EXPECTATIONS. OVERALL, AND OVER THE ARC OF HIS CAREER AT CAROMONT, THE RETIRING CEO'S LEADERSHIP HAS LED CAROMONT HEALTH FROM A MERE COMMUNITY HOSPITAL INTO A REGIONAL HEALTHCARE POWERHOUSE. THE COMMITTEE CONCLUDED THAT HIS LEADERSHIP HAD OUTPERFORMED THE REGION AND FULFILLED THE COMMUNITY'S DESIRE TO KEEP ITS HEALTHCARE SYSTEM UNDER LOCAL CONTROL, THEREBY JUSTIFYING HIS RETIREMENT PAYMENT AS FAIR AND REASONABLE COMPENSATION FOR OUTSTANDING PERFORMANCE.
  FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 IS MADE AVAILABLE TO THE PUBLIC UPON REQUEST AND ON WWW.GUIDESTAR.ORG.
  FORM 990, PART VI, SECTION C, LINE 19 AT THIS TIME, THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. THE ENTIRE ORGANIZATION'S COMBINED FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST.
CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -47. EQUITY TRANSFER -17,921,425. TOTAL TO FORM 990, PART XI, LINE 5: -17,921,472.
STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS: FORM 990, PART III, LINE 4A THE VISION OF CAROMONT HEALTH, LED BY OUR FLAGSHIP GASTON MEMORIAL HOSPITAL, IS TO BE A NATIONALLY RECOGNIZED LEADER AND VALUED PARTNER IN PROMOTING INDIVIDUAL HEALTH AND VIBRANT COMMUNITIES. CAROMONT HEALTH IS THE HEALTH CARE PROVIDER OF CHOICE FOR GASTON, LINCOLN AND CLEVELAND COUNTIES. THESE ARE RAPIDLY GROWING COMMUNITIES AND WE INTEND TO GROW WITH THE COMMUNITIES WE SERVE. CAROMONT HEALTH IS THE ONLY HEALTH CARE SYSTEM IN GASTON COUNTY WITH ACUTE CARE BEDS FOR THE FORESEEABLE FUTURE. WE CONTINUE TO ATTRACT TOP MEDICAL PROFESSIONALS FROM AROUND THE COUNTRY, WHILE RETAINING SOME OF THE AREA'S BEST PHYSICIANS AND NURSES. WE CONTINUE TO FORM INNOVATIVE COLLABORATIONS TO UPGRADE OUR TECHNOLOGY, CREATING BETTER OUTCOMES FOR OUR PATIENTS AND BETTER MANAGEMENT OF TIME AND MONEY. AND WE WILL CONTINUE TO PLAN NEW FACILITIES AS OUR COMMUNITY CONTINUES TO GROW. OUR GROWING COMMUNITY BRINGS WITH IT CHANGE IN TERMS OF DEMOGRAPHICS, AS WELL ASINFRASTRUCTURE NEEDS. AT THE SAME TIME, THE NATION'S HEALTH CARE INFRASTRUCTURE IS ON THE VERGE OF A SYSTEMIC OVERHAUL WITH FAR-REACHING IMPLICATIONS. FORTUNATELY, CAROMONT IS FOCUSED ON THE FUTURE AND TAKING STEPS TO PREPARE FOR ANTICIPATED CHANGES. WE BELIEVE THAT WE ARE WELL-POSITIONED, NOT ONLY TO EMBRACE THE COMING INNOVATIONS IN OUR NATION'S HEALTH CARE SYSTEM, BUT TO ACTUALLY AFFECT CHANGE THAT WILL BRING ABOUT A HEALTHIER, MORE VIBRANT COMMUNITY. KEY SERVICES AT GASTON MEMORIAL HOSPITAL: - THE BIRTHPLACE IS A WORLD-CLASS BIRTHING CENTER DEDICATED TO FAMILY-FOCUSED CARE IN A SERENE, HOMELIKE ENVIRONMENT - 2,604 BABIES DELIVERED IN 2010 - 52 SINGLE-ROOM BEDS DEVOTED TO MATERNITY CARE - 16-BED LEVEL III NEONATAL INTENSIVE CARE UNIT - CAROMONT HEART CENTER PROVIDES A FULL RANGE OF LIFE-SAVING CARDIAC CARE, INCLUDING OPEN HEART SURGERY - 2,096 DIAGNOSTIC CARDIAC CATHETERIZATIONS PERFORMED IN 2010 - 705 PERCUTANEOUS CORONARY INTERVENTIONS PERFORMED IN 2010 - STRATEGIC PARTNERSHIP WITH COLUMBIA UNIVERSITY MEDICAL CENTER'S HEARTSOURCE PROVIDES PHYSICIAN TRAINING, CLINICAL GUIDANCE AND ACCESS TO COLUMBIA RESEARCH TRIALS - CARDIAC RESEARCH PROGRAM BRINGS THE LATEST ADVANCES TO THE BEDSIDE - SUPPORT GROUPS AND EDUCATIONAL PROGRAMS PROMOTE AND HELP WITH HEALTHY LIFESTYLE CHANGES - CAROMONT CANCER CENTER IS THE ONLY HOSPITALBASED CANCER TREATMENT CENTER IN GASTON COUNTY THAT PROVIDES MEDICAL, RADIATION AND SURGICAL ONCOLOGY - ACCREDITED BY THE NATIONAL ORGANIZATION, AMERICAN COLLEGE OF SURGEONS-COMMISSION ON CANCER - CAROMONT COMPREHENSIVE BREAST CENTER GRANTED A THREE-YEAR/FULL ACCREDITATION DESIGNATION BY THE NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS - PARTICIPATION IN CLINICAL TRIAL STUDIES AVAILABLE - "SYSTEM OF CARE" APPROACH INCLUDES PREVENTION, EDUCATION, TREATMENT, FOLLOW-UP AND SYMPTOM MANAGEMENT - CAROMONT CENTER FOR MENTAL WELLNESS HAS 63 LICENSED BEDS PROVIDING COMPREHENSIVE INPATIENT CARE FOR PATIENTS NEEDING PSYCHIATRIC TREATMENT - 165 ADMISSIONS PER MONTH - 24-HOUR ASSESSMENT STAFF COVERAGE IN EMERGENCY DEPARTMENT - 24-BED ADULT UNIT, 13-BED ADOLESCENT UNIT, 9-BED PRE-ADOLESCENT UNIT - BOARD CERTIFIED PSYCHIATRISTS IN ADULT AND CHILD/ADOLESCENT PSYCHIATRY - INDIVIDUAL AND GROUP COUNSELING, FAMILY THERAPY AND SUBSTANCE ABUSE EDUCATION - EMERGENCY SERVICES CARES FOR MORE THAN 100,000 PATIENTS EACH YEAR - 14,000-SQUARE-FOOT FACILITY - 45 TREATMENT ROOMS, 36 EMERGENCY DEPARTMENT EXAM ROOMS, 9 FAST TRACK EXPRESS CARE ROOMS, 4 TRAUMA ROOMS, 4 CRITICAL CARE ROOMS - 28 BOARD CERTIFIED EMERGENCY MEDICINE PHYSICIANS AND MORE THAN 200 EMERGENCY SERVICES EMPLOYEES - NC RACE PROGRAM PROVIDES RAPID TREATMENT FOR HEART ATTACK PATIENTS - NATIONALLY RECOGNIZED TRAUMA SURGEONS - CHEST PAIN CENTER AND STROKE PROGRAM ACCREDITATION SIGNIFICANT ACCOMPLISHMENTS IN FISCAL YEAR 2011: - CAROMONT HEALTH EMPLOYEE WELLNESS - CAROMONT HEALTH CONTINUES TO FOCUS ON INITIATIVES THAT ENSURE ACCOMPLISHING THE CORPORATE AND TRIPLE AIM GOALS OF 1) INCREASING THE NUMBER OF EMPLOYEES WHO EXERCISE 3 OR MORE TIMES A WEEK, 2) INCREASING THE NUMBER OF EMPLOYEES AT A HEALTHY WEIGHT, 3) INCREASING THE VOLUME OF HEALTHY CAFETERIA SALES, AND 4) INCREASING THE NUMBER OF EMPLOYEES WHO SUCCESSFULLY COMPLETE TOBACCO CESSATION CLASSES. WE CONTINUE TO EDUCATE/ENCOURAGE EMPLOYEES TO PARTICIPATE IN AGE AND GENDER APPROPRIATE HEALTH SCREENINGS AND IN IDENTIFYING BELIEFS HELD BY VARIOUS STAFF MEMBERS THAT SUGGEST A LACK OF NEED TO MAINTAIN HEALTH, THEN EDUCATE TO ENCOURAGE HEALTH MAINTENANCE. - EMPLOYER WELLNESS - IN DECEMBER, 2010, CAROMONT HEALTH CONVENED A GROUP OF HEALTH PARTNERS TO DISCUSS THE HEALTH STATUS OF GASTON COUNTY RESIDENTS. A REVIEW OF THE MOST RECENT (2008) GASTON COUNTY HEALTH ASSESSMENT WAS PERFORMED. AFTER DISCUSSION THE FOLLOWING MISSION STATEMENT WAS AGREED UPON: TO DECREASE THE INCIDENCE OF CHRONIC DISEASE WITHIN THEIR EMPLOYED POPULATION BY DECREASING THE RATE OF OBESITY (FOCUSING ON NUTRITION, ACTIVITY/EXERCISE), DECREASING TOBACCO USE AND INCREASING THE CONSTRUCTIVE MANAGEMENT OF PERSONAL STRESS. IN MARCH, 2011, CAROMONT HEALTH SPONSORED THE GASTON COUNTY HEALTH SUMMIT, INVITING HEALTH PARTNERS, LOCAL BUSINESSES, SOCIAL AGENCIES, MUNICIPALITIES AND GOVERNMENTAL AGENCIES. THE SUMMIT INCLUDED A REVIEW OF THE HEALTH STATUS OF AMERICANS AND ITS COST TO EMPLOYERS, A REVIEW OF THE GASTON COUNTY HEALTH ASSESSMENT AND THE COUNTY HEALTH RANKINGS. THE HISTORY, MISSION AND EMPLOYER-BASED STRATEGY OF THE GASTON COUNTY HEALTH COALITION WAS PRESENTED. THE IHI TRIPLE AIM FRAMEWORK WAS PRESENTED AND COMMENTS WERE MADE BY THE IHI BOARD CHAIR. THREE LOCAL EMPLOYERS PRESENTED THEIR ACTIVITIES AND ACCOMPLISHMENTS IN THE REALM OF EMPLOYEE WELLNESS. THE SUMMIT CULMINATED IN A CALL TO ACTION WITH MUCH DISCUSSION. AS A RESULT FIVE MORE EMPLOYERS COMMITTED TO THE WORK OF THE COALITION. PRESENTLY THERE ARE 12 EMPLOYERS REPRESENTED, WHICH INCLUDE 4 OF THE LARGEST EMPLOYERS IN GASTON COUNTY. THIS WORK IS DIVIDED INTO THREE PARTS: INCREASING HEALTH, DECREASING COST AND INCREASING EXPERIENCE OF CARE FOR A DEFINED POPULATION. THE MISSION OF THE INCREASING HEALTH WORKGROUP IS TO EDUCATE MEMBERS REGARDING OPPORTUNITIES TO DECREASE THEIR HEALTHCARE COSTS AND INCREASE THE HEALTH STATUS OF THEIR EMPLOYED LIVES AND TO COACH EMPLOYERS TO DEVELOP, IMPLEMENT AND SUCCESSFULLY SUSTAIN HEALTH INITIATIVES WITHIN THEIR EMPLOYEE BASE. TOOLS USED WILL INCLUDE WELLSOURCE'S HEALTH RISK APPRAISAL, PERSONAL REPORT, EXECUTIVE SUMMARY AND A PRODUCTIVITY AND ECONOMIC BENEFIT REPORT. CAROMONT HEALTH HAS AGREED TO PROVIDE HEALTH RISK APPRAISALS TO ORGANIZATIONS READY TO ACTIVELY PARTICIPATE. TO ENHANCE CARE, RESULTS OF THESE HEALTH SCREENS ARE SENT TO THE EMPLOYEE'S PRIMARY CARE PHYSICIAN. THE DECREASING COST WORK GROUP IS COLLECTING DATA FROM MEMBERS ABOUT THEIR CURRENT COSTS TO ASCERTAIN OPPORTUNITIES FOR COST SAVINGS. THEY ARE ALSO DISCUSSING THE NEED FOR A 24/7 NURSE TRIAGE LINE. THE EXPERIENCE OF CARE WORKGROUP IS DETERMINING THE CURRENT METHODS USED TO ACCESS CARE, DEVELOPING THE MOST APPROPRIATE METHODS TO ACCESS CARE AND WILL DEVELOP AN ACTION PLAN TO MOVE FROM CURRENT TO IDEAL STATE. EDUCATING POPULATIONS ON THESE METHODS WILL BE INCLUDED IN THIS WORK. - FAITH BASED COMMUNITIES - THE FAITH AND HEALTH MINISTRY OF GASTON COUNTY (FHMGC) IS A CAROMONT HEALTH SUPPORTED, CHURCH-BASED WELLNESS PROGRAM DESIGNED TO ENHANCE THE HEALTH STATUS OF THE RESIDENTS OF GASTON COUNTY BY 1)EMPOWERING INDIVIDUALS IN KNOWLEDGE OF AND ACCESS TO COMMUNITY RESOURCES AND AGENCIES, 2) ENHANCING AWARENESS OF THE ABUNDANT LIVING PROGRAM TO THE COMMUNITY, 3) ENHANCING THE PARTNERSHIP WITH CAROMONT HEALTH AND COMMUNITY RESOURCES AND 4) INCREASING THE AWARENESS OF LIFESTYLE RISK FACTORS FOR PREVENTABLE DISEASES. WITH THE CONGREGATIONAL MINISTER'S COMMITMENT, THE ESTABLISHMENT OF CONGREGATIONAL HEALTH MINISTRIES (WELLNESS COMMITTEES) AND THE INVOLVEMENT OF VOLUNTEER CONGREGATIONAL HEALTH PROMOTERS (TYPICALLY RNS) THE STRUCTURE IS ESTABLISHED TO PROVIDE THE SUPPORT, ENCOURAGEMENT, EDUCATION AND RESOURCES TO ENHANCE HEALTH OF CONGREGATION MEMBERS. IMPLEMENTING PROGRAMS IN 4-6 CHURCHES IS A SHORT TERM GOAL. FOUR LOCAL CHURCHES HAVE RECENTLY SIGNED COVENANTS TO PARTICIPATE AND THEIR NINE CONGREGATIONAL HEALTH PROMOTERS ARE IN THE PROCESS OF BEING TRAINED BY CAROMONT'S PARISH NURSE COORDINATOR.
    - IN FEBRUARY 2011, CAROMONT HEALTH OPENED OUR FIRST CLIC IMMEDIATE CARE CLINIC. CLIC (WHICH STANDS FOR CONVENIENT, LOCAL, IMMEDIATE CARE) PROVIDES PATIENTS WITH IMMEDIATE ATTENTION TO THEIR ACUTE HEALTH CARE NEEDS, AS WELL AS INFORMATION, RESOURCES AND SUPPORT TO IMPROVE THEIR LONG-TERM HEALTH AND WELL-BEING. UNLIKE TRADITIONAL URGENT CARE CLINICS, CLIC PROVIDES USER-FRIENDLY, INTERACTIVE OPPORTUNITIES THAT CONNECT PATIENTS TO RESOURCES ACROSS A CONTINUUM OF CARE, INCLUDING STRESS MANAGEMENT, FITNESS AND NUTRITION. - LAST SEPTEMBER, CAROMONT HEALTH PERFORMED OUR 100TH DA VINCI ROBOTIC PROCEDURE. THE DA VINCI SYSTEM IS A SOPHISTICATED ROBOTIC PLATFORM THAT ALLOWS CAROMONT HEALTH TO PERFORM MORE COMPLICATED PROCEDURES IN A MINIMALLY INVASIVE WAY. THAT MEANS SMALLER INCISIONS, LESS PAIN FOR THE PATIENT, A FASTER RECOVERY TIME AND HIGHER PATIENT SATISFACTION. - IN 2011, CAROMONT HEALTH BEGAN USING ATHENAHEALTH'S CLOUD-BASED MEDICAL BILLING AND PRACTICE MANAGEMENT SERVICE TO INTEGRATE ELECTRONIC HEALTH RECORDS AND FACILITATE COMMUNICATION BETWEEN PHYSICIANS AND PATIENTS. PHYSICIANS HAVE EASIER ACCESS TO PATIENT INFORMATION AND CLINICAL DATA, ENHANCING EFFICIENCY, COORDINATION OF CARE AND USE OF TIME IN DIRECT PATIENT CARE. THE COMMUNICATOR SERVICE EXPANDS ACCESSIBILITY FOR PATIENTS AFTER-HOURS, STREAMLINES PATIENT PAYMENTS, RE-CAPTURES STAFF AND PHYSICIAN TIME AND REDUCES PAPER-BASED MAILING CAMPAIGNS. THE NEW ATHENAHEALTH SYSTEM HELPS CAROMONT PHYSICIANS DO WHAT THEY DO BEST - DELIVER EXCEPTIONAL HEALTH CARE, PROMOTE INDIVIDUAL WELLNESS AND ULTIMATELY CREATE A VIBRANT COMMUNITY. - THE GOLD STAR STANDARD HOSPITALS AWARD FROM THE NC PREVENTION PARTNERS RECOGNIZED CAROMONT'S HIGH STANDARD OF EXCELLENCE FOR TOBACCO CESSATION PROGRAMS OFFERED TO ITS EMPLOYEES. CAROMONT HEALTH HAS BEEN TOBACCO-FREE SINCE JANUARY 2007, AND HAD ALREADY IMPLEMENTED MANY TOBACCO CESSATION PROGRAMS FOR EMPLOYEES AND THE COMMUNITY. EMPLOYEES WHO COMPLETE A CERTIFICATION OF TOBACCO-FREE STATUS FOR AT LEAST 12 MONTHS CAN RECEIVE AN ANNUAL DEPOSIT TO THEIR HEALTH INSURANCE INCENTIVE ACCOUNT. - IN 2010, CAROMONT HEALTH HAD 41 ORGAN, TISSUE AND EYE DONORS THROUGH ITS DYNAMIC PARTNERSHIP WITH LIFESHARE OF THE CAROLINAS, AN ORGAN PROCUREMENT ORGANIZATION THAT IMPROVES THE QUALITY OF HUMAN LIFE BY ENCOURAGING PATIENTS TO DONATE ORGANS AND TISSUE. - CAROMONT HEALTH RECENTLY BROKE GROUND ON A SIGNIFICANT EXPANSION FOR ITS AFFILIATED HEALTH FACILITY, GASTON HOSPICE. NAMED AFTER A PIONEER OF GASTON COUNTY HOSPICE, THE ROBIN JOHNSON HOUSE IS DESIGNED TO DELIVER SHORT-TERM CARE AS AN ALTERNATIVE TO HOSPITALIZATION FOR THE MANAGEMENT OF PAIN AND SYMPTOMS. GASTON HOSPICE GREATLY NEEDED TO EXPAND THEIR INPATIENT FACILITY DUE TO THE CURRENT WAITING PERIOD. THE ROBIN JOHNSON HOUSE IS OFTEN FULL, AND PATIENTS HAVE TO WAIT A DAY OR TWO TO RECEIVE NEEDED CARE. THE NEW ADDITION AT THE ROBIN JOHNSON HOUSE IN DALLAS WILL ADD SEVEN ROOMS, BRINGING THE TOTAL FROM 12 TO 19, AND WILL ACCOMMODATE ADDITIONAL PATIENTS WITH QUALITY CARE AND COMFORT WITHOUT A WAIT. THE INPATIENT FACILITY EXPANSION WILL BRING MANY OPPORTUNITIES TO OUR CAROMONT HEALTH COMMUNITY. THE ROBIN JOHNSON HOUSE WILL BE BUILT AND FURNISHED THROUGH THE GENEROUS CONTRIBUTIONS OF INDIVIDUALS, BUSINESSES AND FOUNDATIONS. - IN APRIL 2011, CAROMONT HEALTH WAS RATED AS A TOP HOSPITAL IN THE CHARLOTTE METROPOLITAN AREA BY U.S. NEWS & WORLD REPORT. THE MAGAZINE'S "BEST HOSPITALS" RANKINGS EXAMINED NEARLY 5,000 HOSPITALS ACROSS THE NATION, AND CAROMONT HEALTH'S GASTON MEMORIAL HOSPITAL RANKED SECOND AMONG THE 16 CHARLOTTE-AREA HOSPITALS IN TERMS OF THEIR NATIONALLY RANKED SPECIALTIES. GASTON MEMORIAL HOSPITAL HAD SIX HIGH-PERFORMING SPECIALTIES, INCLUDING GYNECOLOGY, UROLOGY, GASTROENTEROLOGY, GERIATRICS, KIDNEY DISORDERS AND PULMONOLOGY. - BECKER'S HOSPITAL REVIEW PUBLISHED ITS 65 GREAT COMMUNITY HOSPITALS, AND GASTON MEMORIAL MADE THE LIST. HONORED HOSPITALS ARE RECOGNIZED AS HIGH-PERFORMING LEADERS IN PATIENT CARE, CLINICAL QUALITY AND COMMUNITY OUTREACH. THEY INCLUDE HOSPITALS WITH FEWER THAN 550 PATIENT BEDS AND MINIMAL TEACHING PROGRAMS. TO COMPILE THE LIST AND IDENTIFY OUTSTANDING CONTENDERS, THE BECKER'S HOSPITAL REVIEW EDITORIAL TEAM ANALYZED AND REVIEWED DATA FROM SOURCES INCLUDING U.S. NEWS & WORLD REPORT, HEALTHGRADES, AMERICAN NURSES CREDENTIALING CENTER AND THOMSON REUTERS. - CAROMONT HEALTH WAS ONE OF ONLY TWO HOSPITALS IN NORTH CAROLINA TO RECEIVE THE HEALTHGRADES DISTINGUISHED HOSPITAL FOR CLINICAL EXCELLENCE AWARD. HEALTHGRADES OBJECTIVELY IDENTIFIES HOSPITALS ACROSS 26 DIAGNOSES AND PROCEDURES TO FIND THE BEST PERFORMERS. THESE INSTITUTIONS ARE IN THE TOP 5% OF THE NATION IN MEASURES OF OVERALL PERFORMANCE, INCLUDING PATIENT CARE, OPERATIONAL EFFICIENCY AND FINANCIAL STABILITY. - CARECHEX IS A RATING SERVICE OF THE DELTA GROUP THAT MEASURES MEDICAL AND HOSPITAL QUALITY. FOR 2011, THE SERVICE RANKED CAROMONT HEALTH NO. 1 IN NORTH CAROLINA FOR CORONARY BYPASS SURGERY, HEART ATTACK TREATMENT, HEART FAILURE TREATMENT, AND PNEUMONIA CARE. CAROMONT RANKED AMONG THE TOP 10% OF U.S. HOSPITALS IN 11 DIFFERENT CATEGORIES. THIS COMPREHENSIVE EVALUATION PROVIDES FEEDBACK ON THE PROCESS OF CARE, OUTCOMES OF CARE AND PATIENT EXPERIENCES. - CAROMONT HEALTH RANKED AS A TOP PERFORMER IN THE PREMIER ALLIANCE QUALITYADVISOR DATABASE FOR COST OF CARE, LENGTH OF STAY, AND AVOIDABLE MORTALITY. PREMIER INC. ASSESSES THE PROCESSES AND OUTCOMES IN HOSPITAL SYSTEMS TO ENSURE THAT FACILITIES ARE ACHIEVING THEIR GOALS. THESE RANKINGS ALLOW MEMBERS TO MEASURE THEIR OUTCOMES AGAINST LEADING CLINICAL EFFICIENCY AND QUALITY PERFORMANCE BENCHMARKING APPLICATIONS IN THE HEALTH CARE INDUSTRY. THE STANDINGS ARE CALCULATED YEARLY ACROSS ALL PREMIER QUALITYADVISOR FACILITIES. - THE CAROMONT CANCER CENTER IS DESIGNATED AS A COMMUNITY HOSPITAL COMPREHENSIVE CANCER PROGRAM BY THE COMMISSION ON CANCER. THE CANCER CENTER ACHIEVED A FULL THREE-YEAR ACCREDITATION WITH COMMENDATION STATUS AND NATIONAL RECOGNITION AS A RECIPIENT OF THE "OUTSTANDING ACHIEVEMENT AWARD" DURING ITS LAST REVIEW. ONLY 7% OF SURVEYED HOSPITALS RECEIVE THIS AWARD. IN ADDITION, THE AMERICAN COLLEGE OF RADIOLOGY (ACR) HAS NATIONALLY ACCREDITED MAMMOGRAPHY, BREAST ULTRASOUND, BREAST MRI AND BIOPSY WITHIN THE CAROMONT PROGRAM. IN 2011, THE ACR NATIONALLY ACCREDITED THE RADIATION ONCOLOGY PROGRAM, MAKING IT THE ONLY NATIONALLY ACCREDITED PROGRAM WITHIN THE REGION. - CAROMONT HEALTH IS ACCREDITED BY THE SOCIETY OF CHEST PAIN CENTERS (SCPC), AN INTERNATIONAL ORGANIZATION DEDICATED TO ELIMINATING HEART DISEASE AS THE NUMBER ONE CAUSE OF DEATH WORLDWIDE. THE SCPC ACCREDITATION PROCESS GUARANTEES THAT HEALTH CARE FACILITIES MEET OR EXCEED THE QUALITY-OF-CARE MEASURES IN ACUTE CARDIAC MEDICINE. KEY AREAS IN WHICH AN ACCREDITED CHEST PAIN CENTER MUST DEMONSTRATE EXPERTISE INCLUDE INTEGRATING THE EMERGENCY DEPARTMENT WITH THE LOCAL EMERGENCY MEDICAL SYSTEM, CONTINUALLY SEEKING TO IMPROVE PROCESSES AND PROCEDURES, ENSURING THE ONGOING TRAINING OF ACCREDITED CHEST PAIN CENTER PERSONNEL AND SUPPORTING COMMUNITY OUTREACH AND EDUCATIONAL PROGRAMS. - THE NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS (NAPBC) GRANTED CAROMONT'S NEW MULTIDISCIPLINARY BREAST CENTER NATIONAL ACCREDITATION IN 2011. NAPBC-ACCREDITATION IS GIVEN ONLY TO THOSE CENTERS THAT HAVE VOLUNTARILY COMMITTED TO PROVIDE THE BEST IN BREAST CANCER DIAGNOSIS AND TREATMENT. IN ADDITION, THESE CENTERS UNDERGO A RIGOROUS PERFORMANCE EVALUATION AND COMPLY WITH NAPBC STANDARDS FOR TREATING THE FULL SPECTRUM OF BREAST DISEASE. ACCORDING TO THE NAPBC, THE MULTIDISCIPLINARY BREAST CENTER AT CAROMONT DEMONSTRATES PROFICIENCY IN THE AREAS OF CENTER LEADERSHIP, PATIENT CLINICAL MANAGEMENT, RESEARCH, COMMUNITY OUTREACH, PROFESSIONAL EDUCATION AND QUALITY IMPROVEMENT. - THE JOINT COMMISSION RECERTIFIED CAROMONT HEALTH IN 2010 FOR ITS HIP AND KNEE PROGRAMS. THE RECERTIFICATION DEMONSTRATED CAROMONT'S COMPLIANCE WITH CONSENSUS-BASED NATIONAL STANDARDS, EFFECTIVE USE OF EVIDENCE-BASED CLINICAL PRACTICE GUIDELINES TO MANAGE AND OPTIMIZE CARE, AND AN ORGANIZED APPROACH TO PERFORMANCE MEASUREMENT AND IMPROVEMENT ACTIVITIES. IT REFLECTS CAROMONT'S COMMITMENT TO HIGH STANDARDS OF SERVICE. - THE CAROMONT MEDICAL STAFF INCLUDES PHYSICIAN COUNCILS - GROUPS OF PHYSICIANS FROM A RANGE OF DISCIPLINES FOCUSED ON A PARTICULAR PATIENT POPULATION, DISEASE CONDITION OR CARE CONTINUUM. THESE COUNCILS ARE USED AS FORUMS TO EVALUATE AND ALIGN NEW SERVICES, ENHANCE CARE COORDINATION, SHARPEN FOCUS AND STREAMLINE THE HEALTH CARE OPERATING SYSTEM. CAROMONT EXECUTIVES USE THE INFORMATION AND IDEAS THAT COME FROM PHYSICIAN COUNCILS TO MAKE IMPROVEMENTS THROUGHOUT THE HOSPITAL SYSTEM TO BETTER SERVE OUR PATIENTS.
    - THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE IS A PRIVATE, NONPROFIT ORGANIZATION DEDICATED TO IMPROVING HEALTH CARE QUALITY. RECENTLY, SEVEN CAROMONT MEDICAL GROUP PRIMARY CARE PRACTICES RECEIVED NCQA LEVEL 3 RECOGNITION FROM THE PHYSICIAN PRACTICE CONNECTIONS - PATIENT-CENTERED MEDICAL HOME PROGRAM (PCMH). MEDICAL HOME PROGRAMS EMPHASIZE CARE, COORDINATION AND COMMUNICATION, WHICH ARE DESIGNED TO LEAD TO HIGHER QUALITY AND LOWER COSTS. CAROMONT HEALTH'S COMMITMENT TO QUALITY CARE IS BASED ON A CORE DESIRE TO ACHIEVE A HEALTHIER COMMUNITY. - THE CAROMONT ONCOLOGY COUNCIL FORMED THE MULTIDISCIPLINARY BREAST CENTER IN 2011 AS A NEW MODEL OF INTEGRATED ONCOLOGY CARE TO EXPEDITE COMPREHENSIVE TREATMENT, IMPROVE OUTCOMES, AND ULTIMATELY, SAVE LIVES. PATIENTS BENEFIT FROM A COMPREHENSIVE EVALUATION AND PERSONALIZED TREATMENT PLAN RECOMMENDED BY A MULTIDISCIPLINARY TEAM OF BOARD CERTIFIED MEDICAL ONCOLOGISTS, RADIATION ONCOLOGISTS, SURGEONS AND RADIOLOGISTS. THE MULTIDISCIPLINARY BREAST CENTER TEAM RECOGNIZES THE IMPORTANCE OF THE REFERRING PHYSICIANS IN ONGOING INTEGRATED CARE AND PROVIDES REFERRING PHYSICIANS WITH DETAILED DOCUMENTATION OF THE BREAST CENTER'S MULTIDISCIPLINARY TEAM'S FINDINGS AND RECOMMENDATIONS. - CAROMONT'S CANCER CENTER AND THE AMERICAN CANCER SOCIETY HAVE PARTNERED TO PROVIDE A CANCER RESOURCE CENTER THAT PROVIDES PATIENTS AND CAREGIVERS TIMELY INFORMATION AND SUPPORT TO HELP THEM MANAGE THE DIAGNOSIS OF CANCER. THE CENTER PROVIDES HIGHLY TRAINED VOLUNTEERS WHO CAN GUIDE CANCER PATIENTS THROUGH ALL CHALLENGES OF THE CANCER JOURNEY SUCH AS FINANCIAL CONCERNS, INSURANCE AND TRANSPORTATION. - CAROMONT HEALTH IS ENTERING THE SECOND YEAR OF OUR PARTNERSHIP WITH COLUMBIA UNIVERSITY MEDICAL CENTER'S HEARTSOURCE, A CLINICAL AND MANAGEMENT SERVICES GROUP FROM THE DIVISION OF CARDIOTHORACIC SURGERY AT NEW YORK PRESBYTERIAN HOSPITAL/COLUMBIA UNIVERSITY MEDICAL CENTER. THE RELATIONSHIP HAS PROVIDED CAROMONT HEALTH PHYSICIANS WITH EXPOSURE TO SOME OF THE MOST ADVANCED CARDIAC PROCEDURES, AS WELL AS ACCESS TO A SHARED QUALITY CONTROL DATABASE. IT ALSO ALLOWS FOR A HIGHER LEVEL OF FOCUS ON QUALITY OUTCOMES AND EVIDENCE-BASED CARE THAT MIGHT NOT EXIST IN ISOLATED, PRIVATE PRACTICES. - CAROMONT HEALTH AND NORTH CAROLINA'S LARGEST HEALTH INSURER, BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA, ANNOUNCED A COLLABORATIVE ARRANGEMENT TO OFFER PATIENTS A NEW HEALTH CARE DELIVERY AND REIMBURSEMENT MODEL FOR KNEE REPLACEMENTS. THE INNOVATIVE, VALUE-BASED INITIATIVE IS DESIGNED TO PROVIDE QUALITY CARE WITH IMPROVED CARE COORDINATION AT COMPETITIVE PRICING. SPECIFIC QUALITY AND PATIENT SATISFACTION MEASURES ARE BUILT IN TO THE 'BUNDLED KNEE' PLAN TO HELP ENSURE THAT PATIENT NEEDS GUIDE THE PROGRAM. - THE INSTITUTE FOR HEALTHCARE IMPROVEMENT HAS ESTABLISHED A TRIO OF OBJECTIVES CALLED THE TRIPLE AIM: - IMPROVE THE HEALTH OF THE POPULATION - ENHANCE THE PATIENT EXPERIENCE (QUALITY, ACCESS, RELIABILITY) - CONTROL COSTS THESE THREE OBJECTIVES ARE ALL CRITICAL COMPONENTS IN BEING WHAT IS KNOWN IN THE INDUSTRY AS AN ACCOUNTABLE CARE ORGANIZATION (ACO). IN TAKING STEPS TO BECOME AN ACO, CAROMONT HEALTH IS UNDERTAKING CHANGES THAT WILL LEAD TO BETTER COORDINATED CARE WITH BETTER OUTCOMES AT LOWER COSTS FOR PATIENTS. WE ARE ALSO EMBRACING THE "MEDICAL HOME" CONCEPT, WHICH IS A NATIONAL INITIATIVE DESIGNED TO IMPROVE HEALTH CARE QUALITY. MEDICAL HOMES ARE PATIENT CENTERED, TEAM-BASED APPROACHES TO CARE THAT HAVE BEEN SHOWN TO REDUCE HOSPITAL ADMISSIONS AND DECREASE COSTS.
COMMON PAYMASTER FORM 990, PART V AND PART VII THE FILING ORGANIZATION USES A RELATED ORGANIZATION FOR ITS PAYROLL FUNCTION. ALL W-2S ARE FILED BY THE COMMON PAYMASTER. HOWEVER, AMOUNTS PAID BY THE COMMON PAYMASTER ARE TREATED AS IF PAID DIRECTLY BY THE ORGANIZATION FOR WHICH SERVICES ARE PERFORMED.
  AMENDED RETURN: THE 2010 FORM 990 WAS AMENDED TO CORRET AN ERROR ON SCHEDULE K, PART II, COLUMM (B), LINE 10. THE AMOUNT IN THE ORIGINAL FILING WAS OVERSTATED BY $1 MILLION. THE AMOUNT HAS BEEN AMENDED TO CORRECTLY STATE THE AMOUNT $28,947,486.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


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SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
GASTON MEMORIAL HOSPITAL INC
 
Employer identification number

56-0619359
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) CAROMONT HEALTH INC

2525 COURT DRIVE

GASTONIA,NC28054
58-1636959 		MEDICAL SERVICES NC 501(C)(3) LINE 11B, II N/A
 
No
(2) CAROMONT HEALTH SERVICES INC

2526 COURT DRIVE

GASTONIA,NC28054
56-1455630 		OUTPATIENT SERVICES NC 501(C)(3) LINE 3 CAROMONT HEALTH INC
 
 
No
(3) GASTON MEMORIAL HOSPITAL FOUNDATION INC

2527 COURT DRIVE

GASTONIA,NC28054
56-1479699 		FOUNDATION NC 501(C)(3) LINE 9 CAROMONT HEALTH INC
 
 
No
(4) CAROMONT MEDICAL GROUP INC

2528 COURT DRIVE

GASTONIA,NC28054
56-1479712 		MEDICAL GROUP NC 501(C)(3) LINE 9 CAROMONT HEALTH INC
 
 
No
(5) HOSPICE OF GASTON COUNTY INC

2529 COURT DRIVE

GASTONIA,NC28054
58-1341530 		HOSPICE CARE NC 501(C)(3) LINE 7 CAROMONT HEALTH INC
 
 
No
(6) GASTON EMERGENCY PHYSICIANS INC

2531 COURT DRIVE

GASTONIA,NC28054
56-2209423 		SUPPORTING ORGANIZATION NC 501(C)(3) LINE 11A, I CAROMONT HEALTH INC
 
 
No


For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership












Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1)
(2)
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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